Well, of course, Adrian was the closest; in all honesty WHO would be
around at 4am to see a patient like that? So the answer is you manage it
by delegation, and wait for the delegatee(s) to pick up any red flags,
as John puts it. And, frankly, there aren't any. The man is apyrexial
with local tenderness. He has no signs of systemic infection, so the
person who sees him decides to rule out a DVT. We don't use D-dimers at
this site, we use a plethysmographic device called a venometer, which is
supposed to be 100% sensitive (SnNout) although as we know, never should
you say never in medicine.
The venometer is negative, so the man is allowed home with advice and
painkillers.
He is brought back 12 hours later moribund with a temperature of 35, a
pulse of 140 and an unrecordable blood pressure. His leg now looks
bruised and the rest of him is mottled. What has happened and what would
you do now?
/Rowley./
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